Provider Demographics
NPI:1326410077
Name:STREDNAK, JENI (MAMFT)
Entity type:Individual
Prefix:
First Name:JENI
Middle Name:
Last Name:STREDNAK
Suffix:
Gender:F
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 JULIAN LN APT D
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-9595
Mailing Address - Country:US
Mailing Address - Phone:270-218-2988
Mailing Address - Fax:
Practice Address - Street 1:104 JULIAN LN APT D
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127-9595
Practice Address - Country:US
Practice Address - Phone:270-218-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMFTMFA00221417106H00000X
KY245953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist